Treatment
➤ ➤ Rate control is preferred over rhythm control for the majority of patients
who have atrial fibrillation (S-M). Preferred options for rate-control
therapy include non-dihydropyridine calcium channel blockers and beta
blockers. Rhythm control may be considered for certain patients based
on patient symptoms, exercise tolerance, and patient preferences (W-L).
➤ ➤ Lenient rate control (<110 beats per minute resting) is preferred over
strict rate control (<80 beats per minute resting) for patients who have
atrial fibrillation (W-L).
➤ ➤ Clinicians should discuss the risk of stroke and bleeding with all patients
considering anticoagulation (GP). Clinicians should consider using the
continuous CHADS
2
or continuous CHA
2
DS
2
-VASc for prediction of risk
of stroke (W-L) and HAS-BLED for prediction of risk for bleeding (W-L) in
patients who have atrial fibrillation.
➤ ➤ Patients who have atrial fibrillation should receive chronic
anticoagulation unless they are at low risk of stroke (CHADS
2
<2)
or have specific contraindications (S-H).
• Choice of anticoagulation therapy should be based on patient preferences and
patient history. Options for anticoagulation therapy may include warfarin, apixaban,
dabigatran, edoxaban, or rivaroxaban.
➤ ➤ Dual treatment with anticoagulant and antiplatelet therapy is NOT
recommended for most patients who have atrial fibrillation (S-M).
Table 1. CHADS
2
Risk Assessment Score
Risk Factor Score (if present)
C
Congestive heart failure
1
H
Hypertension
1
A
Age ≥75 y
1
D
Diabetes mellitus
1
S
Prior stroke or TIA
2
Total Score for a maximum of 6
